Mitral valve replacement with & without posterior mitral leaflet preservation.

Riaz Anwar Khan; Abdul-Malik; Sohail Aslam; Khalid Rehman; Nayyar Waseem; Taskeen Ahmad; Hamid Ahmad; Jalal Khan; Parvez Mannan

Incidence of Rheumatic heart disease with damage to mitral valve is high in our country. In mitral valve surgery, the importance of continuity of posterior mitral leaflet preservation in retaining left ventricular function is very important. This study was done to assess the clinical outcome of two groups of patients with & without preservation of Posterior Mitral leaflet during Mitral Valve Replacement. From June 1993 to December 2003, data was retrieved from the hospital records of the patients who underwent Mitral Valve Replacement. Patients were divided in two groups: Group A (fifty one patients) from 1993 to December 1999 where posterior mitral leaflet was excised. Group B (seventy one patients) from January 2000 to December 2003 where posterior mitral leaflet was preserved. Data was analyzed in both groups regarding age, sex, NYHA status, Echocardiographic findings, total cardiopulmonary bypass, cross clamp time, electrical cardioversion after declamping, perioperative arrhythmias, use of inotropes while coming off bypass. In post operative period the duration of ventilatory support, use of inotropes, diuretics, antiarrhythmic drugs, mortality and morbidity was assessed. Post operative follow-up assessment was done by NYHA status and echocardiographic findings at six, twelve and twenty four weeks. There was no significant difference in cross clamp, cardio pulmonary bypass time in both groups. While the spontaneous recovery rate after declamping in Group A was (39.21%) versus Group B (80.73%). Electrical cardioversion rate after declamping was more in Group A (60.78%) versus Group B (07.04%). Use of inotropes were 90.19% in Group A and 60.55% in Group B while coming off bypass. Mortality rate was 27.45% in Group A versus 08.45% in Group B. Similarly mechanical ventilatory support time was more in Group A (mean 15.20 hours) versus Group B (mean 05.40 hours). Mean duration of inotropic support in Group A was (22 hours) versus Group B(09 hours). Major arrhythmias control rate by IV amiodarone in Group A was (25.49 %) and in Group B (05.63%). Preservation of posterior mitral leaflet is a better option then excising it in mitral valve replacement.